Harried flight, marathon surgery behind first US penis transplant

In a 15-hour procedure earlier this month, a Massachusetts man received the first penis transplant in the US.AP Video

The timing could hardly have been worse. Just when an organ became available for the first-ever penis transplant in the United States, almost every last urologist in the country was at a conference in San Diego, Calif.

Within 24 hours, Dr. Dicken Ko would be back in Boston performing the operation. He booked the next flight he could find, and called a colleague so that the operating room would be ready. Ko’s wife picked him up at the airport in the middle of the night, and drove him straight to Massachusetts General Hospital, where he is the director of urology.

On one table was the donated penis, kept on ice. On another was the patient, Thomas Manning, a 64-year-old bank courier from Halifax, Mass.

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In 2012, Manning had gone into the hospital because of an accident in the mailroom where he worked. His injury was in his groin area, but when the doctors began examining him, they saw something else: a growth that looked like penis cancer. “He hadn’t recognized it himself,” said Dr. Adam Feldman, Manning’s oncologist at Mass General.

To increase his chances of survival, the team had had to amputate most of his penis, leaving little more than a stump. Manning proposed himself as a candidate for a penile transplant.

And after a battery of tests both physical and psychological, and a wait of a few weeks, the operation began on May 8, when an organ from a deceased donor became available. In order for that donated penis to be used for this experimental operation, the New England Organ Bank asked for special permission from the donor’s family.

The surgeons began with the urethra, suturing the donor organ to Manning’s stump under a microscope. “That anchors everything down,” Ko told STAT.

Then they could wire up the blood vessels and the nerves. But just then, they ran into a problem. The pre-op scans had made it look like Manning’s arteries were flowing well enough to simply suture them together with those in the donor organ.

But one artery was not big enough. “You could see the diameter was too small. Most experienced surgeons can tell that,” Ko said.

So they moved immediately to plan B: They took a bit of a blood vessel from the top of Manning’s leg and spliced it in to ensure proper blood flow.

The operation lasted approximately 15 hours. Manning is doing well. On Friday, less than a week after the operation, he was out of bed, according to the New York Times.

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This operation has been attempted before overseas. Surgeons have been successful at re-attaching patients’ own penises for years, but in 2006, two weeks after Chinese surgeons grafted a cadaver’s penis onto a patient, he asked for the transplant to be removed, for psychological reasons. Then, in 2014, surgeons in South Africa performed a penis transplant on a 24-year-old man who had lost his organ because of infection after a ritual circumcision. Just six months after the transplant, the patient told his surgeons that his girlfriend was pregnant.

In February, surgeons at Johns Hopkins announced that they had selected a soldier wounded in a bomb blast in Afghanistan as the first American recipient for a penis transplant, but they were still practicing the procedure on cadavers in April.

“We hope that this will be a common part of reconstructive surgery going forward,” said Dr. Curtis Cetrulo, who led the surgical team at Mass General, at a press conference on Monday. He noted that for soldiers returning from Iraq and Afghanistan, genital injuries “can leave them so despondent that they consider taking their own lives, and often do.”

The operation could also potentially have implications for those who identify as transgender and who may want surgery. But, for the moment, the team at Mass General is focused on wounded warriors, cancer patients, and those who have suffered accidents. “The anatomy is very different,” explained Ko, adding that performing a penis transplant on someone who had been born with a female body would require a whole other set of studies.

Cetrulo said that Manning will most probably be on immunosuppression for the rest of his life, which could put him at an increased risk of infections and certain cancers. He still has a catheter in at the moment, but he should be able to urinate normally within weeks, and sexual function may be restored within weeks or months.

Correction: A previous version of this story misstated the amount of time Manning spent on the waiting-list for a donated organ.